VA leadership woes: Readers nearly deadlocked on EHR project path

Since March, the U.S. Department of Veterans Affairs has seen a lot of leadership turnover: 40 senior staffers by the Democrats count in May. The agency lost two more in late summer, with the departure of its EHR project office Chief Medical Officer and Chief Health Informatics Officer.

As the VA just began its EHR modernization project, we asked our readers whether the office should pause the project while it waits for experienced IT leadership. But the near-700 responses were far from clear: 55 percent said to pause, 45 percent said no to stopping the current progress.

Should the VA put its EHR project on hold until it has permanent IT leadership in place?

What’s interesting is that despite those close responses, the majority (63 percent) said they were concerned with the project’s current trajectory. And a glimpse at the poll responses provided one clear result: No one can agree on what to do, what’s right for the VA or whether Cerner was the right choice.

Those in favor of the project highlighted the need for the VA to work with Cerner, the Department of Defense and industry leaders to get the project right.

“There is a culture of using VistA that will need to change. It would be helpful to have the same DoD transition team work directly with VA to assist in the switch over to Cerner,” said one respondent. “The VA needs to get their act together.”

Are you concerned about the project’s current trajectory?

“They need to move forward and start tailoring the EHR to their patient and provider needs,” said another.

Another reader had strong words for everyone involved: “I work for a hospital system in the process of changing all of our EHRs over to a new system. Of course, it's not easy. Change is never easy. There are just too many cooks in the kitchen. Just get over it already like the rest of us 99-percenters have to do, and do what needs to be done.”

Others were unsure of the right path forward, some citing the need for an external investigation and even more saying the VA needs to quickly hire both a CHIO and a chief information officer.

Those against the current path were a bit more direct, revisiting the argument that began when former VA Secretary David Shulkin, MD first proposed the need to replace the legacy VistA system. Those respondents called for Epic -- and for the agency to keep its current platform.

“Revisit the EHR Acquisition at this time - put [the project] on hold,” said one reader. “Create conditions for successful EHR implementation: Do not move forward until these criteria are in evidence.”

“The process is relying too heavily on DoD implementation, which has some serious problems and is still paused,” said another respondent. “VA is driving this without enough Veterans Health Administration input. It’s not an IT project: It’s a healthcare transformation project.”

The reader comments echo similar sentiments from a letter sent by 11 lawmakers to the agency, blasting the modernization progress and the leadership shakeups. The group went as far as to call the lack of leadership ‘malign neglect.’

In fact, a recent letter to VA Secretary Robert Wilkie from Rep. Jim Banks, R-Indiana, said he’s greatly concerned “about the deteriorating and rudderless leadership” at the VA EHR project office and requested Wilkie fill those leadership holes.

Without its CHIO and CMO, Banks said, “at most half of the program’s leadership positions are occupied, and its rank-and-file positions are only sparsely filled, primarily with detailees… It would be a tragedy for the program to be undermined by personality conflicts and bureaucratic power struggles before it even begins in earnest.”

Banks also noted he wasn’t even able to meet with the CHIO and CMO before they resigned.

Congress is also concerned that the VA is attempting to rollout the same platform as the DoD, given the long list of challenges that have plagued that project. The DoD rollout is still on hold, and if a recent amendment to the Senate appropriations bill is passed, the Government Accountability Office will review the project.

But not everyone is concerned with the leadership troubles. An AMVETS spokesperson told Healthcare IT News in a statement: “I don’t necessarily see the turnover in IT leadership as worrisome.”

Instead, the leadership changes indicate that the EHR project is moving forward without “meddling outside interests,” the spokesperson added. “When [Wilkie] left the Pentagon to head the VA, Sec. Mattis specifically asked him to ensure the VA EHR modernization was done right, and we believe he's going to see to it that it is.”